Dementia Care Research and Psychosocial Factors

Older adults (age 65 and over) with mild cognitive impairment (MCI) are 3-5 times more likely to progress to dementia than healthy counterparts. Engaging in cognitively challenging activities in later life is associated with decreased risk of cognitive decline. Music-based training interventions are a promising strategy to address late-life cognitive inactivity, but few interventions have been studied. The goal of this study was to conduct a pilot feasibility/acceptability RCT of a piano improvisation training to determine if a future mechanistic RCT was warranted.

We used RCT design with mixed-methods data collection to examine the feasibility and acceptability of a recently adapted 12-week, group piano improvisation intervention for older adults with and without MCI. We assessed standard feasibility and acceptability metrics. Participants were individually randomized and stratified by centers to either a small group (i) piano improvisation (experimental) or (ii) music listening (attention control) intervention. The interventions (with manuals) were led by a professional musician weekly for 12 weeks (90 minutes) with 4-5 days of 30-minute home practice. We administered pre- and post-intervention assessments, anonymous satisfaction surveys, fidelity checks, and focus groups.

We assessed 70 individuals from three San Francisco senior centers for eligibility; 53 were enrolled (88% of enrollment goal) and randomized (mean age = 75.2 years, 77% female, and 69% non-white). Thirty percent were classified as healthy and 70% as MCI (based on MoCA). Recruitment lasted 18 weeks (average 3/week), lower than our proposed 10/week (due to COVID). Study retention was 81% (exceeding the proposed 75%). Participants attended an average of 10/12 of the experimental and 6/12 of the control sessions. Missing survey data were rare. All participants in the experimental and 93% in the control group rated quality of the sessions as "good, very good, or excellent". Focus group data supported survey findings.

Our pilot RCT met a majority of our feasibility and acceptability thresholds, which supported the decision to move on to a larger, mechanistic trial. We are currently testing the hypothesis that piano improvisation training will improve self-regulation among older adults, which in turn, promotes sustainment of cognitively challenging activities.